Mortgage Loan Application

Basile State Bank Originating Co. NMLS# ID: 460576
William J. Johnson Originator NMLS# ID:  710168
Kimberly L. LeBleu Originator NMLS# ID:  710169
Angela Guillory Originator NMLS# ID:  710170
Matthew Caleb Andrus Originator NMLS# ID: 143396

Important Information:

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.  What this means for you: When you open an account, or apply for a loan, we will ask your name, address, date of birth, and other information that will allow us to identify you.  We may also ask to see your driver's license or other identifying documents.

This application is designed to be completed by the applicant (s) with the lender's assistance. Please indicate whether you intend to apply for individual or joint credit.  Applicants for joint credit should complete the applicable co-borrower sections of the application. Co-borrower information must be provided when the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification, or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the secured property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

You must be a U. S. Citizen with a U.S. address and Social Security number to apply online All other applicants should contact us at 337-432-6646.


APPLICATION INFORMATION

Application for: Amount Requested: $

Application Type: Individual Joint

Purpose of Loan:

If other, please explain:

Property will be:

PROPERTY INFORMATION

Subject Property Address (street, city, state, ZIP code)
Legal Description of Subject Property
 
No. of Units:    Year Built
Complete the next line if construction or construction-permanent loan.
Year Acquired
Original Cost
$
Amt. Existing Liens
$
(a) Present Value of Lot
$
(b) Cost of Improvements
$
Total (a+b)
$
Complete the next line if a refinance loan or home improvement.
Year Acquired
Original Cost
$
Amt. Existing Liens
$
Purpose of Refinance
$
Describe Improvements:

        Cost: $
Title will be held in what Name(s)
Manner in which Title will be held:
Estate will be held in:

If Leasehold, list expiration date:
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)

BORROWER

Name D.O.B.  
Present Street Address

Notice:  Do not enter a P. O. Box unless you are currently serving in the military.

  City: State:   ZIP Code:
Number of Years at this address:     Own Rent
Former Street Address   City: State:   ZIP Code:
(if less than 2 years at present address)
Number of Years at this: Own Rent
Driver's License Number State issued: Phone #
Social Security Number Business Phone
Marital Status
Married
Unmarried
(including single, divorced, widowed)
Separated

Notice: Marital status should only be completed if applicant is applying for joint or secured credit, or if applicant resides in a community property state, or is relying on property located in such a state.

Dependents other than listed by Co-Borrower:   No. Ages
Name of Employer
Street Address
City State   ZIP Code
Years employed in this line of work or profession? yrs.
Years on this job
Self-employed
Position/Title Type of Business

CO-BORROWER

Name D.O.B.  
Present Street Address

Notice:  Do not enter a P. O. Box unless you are currently serving in the military.

  City: State:   ZIP Code:
Number of Years at this address: Own Rent
Former Street Address   City: State:    ZIP Code:
(if less than 2 years at present address)
Number of Years at this address:    Own Rent
Driver's License Number State issued: Phone #
Social Security Number Business Phone
Marital Status
Married
Unmarried
(including single, divorced, widowed)
Separated

Notice: Marital status should only be completed if applicant is applying for joint or secured credit, or if applicant resides in a community property state, or is relying on property located in such a state.

Dependents other than listed by Co-Borrower:   No. Ages
Name of Employer
Street Address
City State ZIP Code
Years employed in this line of work or profession? yrs.
Years on this job
Self-employed
Position/Title Type of Business

GROSS MONTHLY INCOME

MONTHLY HOUSING EXPENSE

Item Borrower Co-Borrower Total Item Total
Base Empl. Income $ $ $ Rent $
Overtime First Mortgage (P&L)
Bonuses Other Financing
Commissions Hazard Insurance
Dividends/Interest Real Estate Taxes
Net Rental Income Mortgage Insur.
Other+
(Before completing, see notice under Describe Other Income below)
Homeowner Assn. Dues
         
         
Total $ $ $   $

DESCRIBE OTHER INCOME
NOTICE: + Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered as a basis for repaying this loan.
Item Monthly Amount
$

IF EMPLOYED IN CURRENT POSITION LESS THAN 2 YEARS COMPLETE THE FOLLOWING

B/C
Previous Emplr./School
City/State
Type of Bus.
Position/Title
Dates
Monthly Income

Assets & Liabilities

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Co-Borrower section was completed about a spouse, this Statement and supporting schedules must be completed about that spouse also.

Completed: Jointly Not Jointly

Assets (Description) Cash or Market Value
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No. $
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No. $
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No. $
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No. $
Stocks & Bonds (Company name/number & description)
$
Life Insurance net cash value:   Face amount: $ $
Subtotal Liquid Assets $
Real Estate owned (enter market value from schedule of real estate owned) $
Vested interest in retirement fund $
Net worth of business(es) owned (attach financial statement) $
Automobiles owned (make and year)

$
$
$
Other Assets (itemize)
$

Total Assets a.

$

Liabilities and Pledged Assets

List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary.

Liabilities Monthly Payment Unpaid Balance
Name and address of Company
$ $
Acct. No.
Name and address of Company
$ $
Acct. No.
Name and address of Company
$ $
Acct. No.
Name and address of Company
$ $
Acct. No.
Name and Address of Company
$ $
Acct. No.
Name and Address of Company
$ $
Acct. No.
Alimony/Child Support/Separate Maintenance Payments Owed to: $  
Job Related Expense (child care, union dates, etc.) $
Total Monthly Payments $
  Total Liabilities b.

SCHEDULE OF REAL ESTATE OWNED

(If Additional Properties Owned Attach Separate Schedule)

Address of Property
Type of Property*
Present Market Value
Amt. of Mort. & Liens
Gross Rental Income
Mort. Paymts.
Taxes, Ins., Maint. and Misc.
Net Rental Income
$ $ $ $ $ $
Totals $ $ $ $ $ $
* Indicate S if Sold, PS if Pending Sale or R if Rental being held for income

LIST PREVIOUS CREDIT REFERENCES

Borrower or CoBorrower
Creditor's Name and Address
Account Number
Purpose
Highest Balance
Date Paid
List any additional names under which credit has previously been received.

DETAILS OF TRANSACTION

a. Purchase Price $
b. Alterations, improvements, repairs $
c. Land (if acquired separately) $
d. Refinance (including debts to be paid off) $
e. Estimated prepaid items $
f. Estimated closing costs $
g. PMI, MIP, Funding Fee $
h. Discount (if Borrower will pay) $
i. TOTAL COSTS (Add items a through h) $
j. Subordinate financing $
k. Other Credits (explain)
$
m. Loan amount (exclude PMI, MIP, Funding Fee financed) $
n. PMI, MIP, Funding Fee financed $
o. Loan amount (add m & n) $
p. Cash from/to Borrower (subtract j,k,l & o from i) $

DECLARATIONS

If you answer "Yes" to any question a through i, please explain in the box below. Borrower Co-Borrower
Yes No Yes No
a. Are there any outstanding judgments against you?
b. Have you been declared bankrupt within the past 7 years?
c. Have you had a property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
d. Are you a party to a law suit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond or loan guarantee. If "Yes", provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the actions.)
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee? If "Yes", give details as described in the preceding question.
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence? If "Yes", complete question m below.
m. Have you had an ownership interest in a property in the last 3 years?

(1) What type of property did you own: principle residence (PR)
second home (SH), or investment property(IP)?

(2) How did you hold title to the home: solely by yourself (S),
jointly with spouse (SP), or jointly with another person (O)?

Explanations:

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race.  For race, you may check more than one designation.  If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname.  If you do not wish to furnish the information, please check the box below.

BORROWER   CO-BORROWER
I do not wish to furnish this information.

I do not wish to furnish this information.

Ethnicity

Hispanic or Latino
Not Hispanic or Latino
 

Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Race/National
Origin

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or
Other Pacific Islander
White
  Race/National
Origin
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or
Other Pacific Islander
White
Sex Female Male   Sex Female Male

ACKNOWLEDGMENT AND AGREEMENT

The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, Its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender without prior notice to me; (9) the Lender, its, agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.

Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

To Be Completed by Interviewer
This application was taken by: Internet Mail Face-to-Face interview Telephone